Racial differences in physical activity among breast cancer survivors : implications for breast cancer care

Background: Physical activity after breast cancer diagnosis is associated with improved survival. This study examines levels of and changes in physical activity following breast cancer diagnosis, overall and by race. Methods: The Carolina Breast Cancer Study, Phase III, assessed pre- and post-diagnosis physical activity levels in a cohort of 1,735 women, aged 20-74, diagnosed with invasive breast cancer between 2008 and 2011 in 44 counties of North Carolina. Logistic regression and analysis of variance were used to examine whether demographic, behavioral and clinical characteristics were associated with activity levels. Results: Only 35% of breast cancer survivors met current physical activity guidelines post-diagnosis. A decrease in activity following diagnosis was reported by 59% of patients, with the average study participant reducing their activity by 230 minutes (95% CI: 190, 270). Following adjustment for potential confounders, when compared to white women, African-American women were less likely to meet national physical activity guidelines post-diagnosis (odds ratio: 1.38, 95% CI: 1.01, 1.88), reported less weekly post-diagnosis physical activity (182 vs. 215 minutes; p=0.13), and reported higher average reductions in pre- versus post-diagnosis weekly activity (262 vs. 230 minutes; p-value = 0.13). Conclusion: Despite compelling evidence demonstrating the benefits of physical activity post-breast cancer, it is clear that more work needs to be done to promote physical activity in breast cancer patients, especially among African-American women.

Exploration of diarrhoea seasonality and its drivers in China

This study investigated the diarrhoea seasonality and its potential drivers as well as potential opportunities for future diarrhoea control and prevention in China. Data on weekly infectious diarrhoea cases in 31 provinces of China from 2005 to 2012, and data on demographic and geographic characteristics, as well as climatic factors, were complied. A cosinor function combined with a Poisson regression was used to calculate the three seasonal parameters of diarrhoea in different provinces. Regression tree analysis was used to identify the predictors of diarrhoea seasonality. Diarrhoea cases in China showed a bimodal distribution. Diarrhoea in children <5 years was more likely to peak in fall-winter seasons, while diarrhoea in persons > = 5 years peaked in summer. Latitude was significantly associated with spatial pattern of diarrhoea seasonality, with peak and trough times occurring earlier at high latitudes (northern areas), and later at low latitudes (southern areas). The annual amplitudes of diarrhoea in persons > = 5 years increased with latitude (r = 0.62, P<0.001). Latitude 27.8° N and 38.65° N were the latitudinal thresholds for diarrhoea seasonality in China. Regional-specific diarrhoea control and prevention strategies may be optimal for China. More attention should be paid to diarrhoea in children <5 years during fall-winter seasons.

Application of higher-order spectra for automated grading of diabetic maculopathy

Diabetic macular edema (DME) is one of the most common causes of visual loss among diabetes mellitus patients. Early detection and successive treatment may improve the visual acuity. DME is mainly graded into non-clinically significant macular edema (NCSME) and clinically significant macular edema according to the location of hard exudates in the macula region. DME can be identified by manual examination of fundus images. It is laborious and resource intensive. Hence, in this work, automated grading of DME is proposed using higher-order spectra (HOS) of Radon transform projections of the fundus images. We have used third-order cumulants and bispectrum magnitude, in this work, as features, and compared their performance. They can capture subtle changes in the fundus image. Spectral regression discriminant analysis (SRDA) reduces feature dimension, and minimum redundancy maximum relevance method is used to rank the significant SRDA components. Ranked features are fed to various supervised classifiers, viz. Naive Bayes, AdaBoost and support vector machine, to discriminate No DME, NCSME and clinically significant macular edema classes. The performance of our system is evaluated using the publicly available MESSIDOR dataset (300 images) and also verified with a local dataset (300 images). Our results show that HOS cumulants and bispectrum magnitude obtained an average accuracy of 95.56 and 94.39 % for MESSIDOR dataset and 95.93 and 93.33 % for local dataset, respectively.

Aggressive surgical interventions for severe stroke: Impact on quality of life, caregiver burden and family outcomes

Introduction: Decompressive hemicraniectomy, clot evacuation, and aneurysmal interventions are considered aggressive surgical therapeutic options for treatment of massive cerebral artery infarction (MCA), intracerebral hemorrhage (ICH), and severe subarachnoid hemorrhage (SAH) respectively. Although these procedures are saving lives, little is actually known about the impact on outcomes other than short-term survival and functional status. The purpose of this study was to gain a better understanding of personal and social consequences of surviving these aggressive surgical interventions in order to aid acute care clinicians in helping family members make difficult decisions about undertaking such interventions. Methods: An exploratory mixed method study using a convergent parallel design was conducted to examine functional recovery (NIHSS, mRS & BI), cognitive status (Montreal Cognitive Assessment Scale, MoCA), quality of life (Euroqol 5-D), and caregiver outcomes (Bakas Caregiver Outcome Scale, BCOS) in a cohort of patients and families who had undergone aggressive surgical intervention for severe stroke between the years 2000–2007. Data were analyzed using descriptive statistics, univariate and multivariate analysis of variance, and multivariate logistic regression. Content analysis was used to analyze the qualitative interviews conducted with stroke survivors and family members. Results: Twenty-seven patients and 13 spouses participated in this study. Based on patient MOCA scores, overall cognitive status was 25.18 (range 23.4-26.9); current functional outcomes scores: NIHSS 2.22, mRS 1.74, and BI 88.5. EQ-5D scores revealed no significant differences between patients and caregivers (p=0.585) and caregiver outcomes revealed no significant differences between male/female caregivers or patient diagnostic group (MCA, SAH, ICH; p=""0.103).<"/span><"/span> Discussion: Overall, patients and families were satisfied with quality of life and decisions made at the time of the initial stroke. There was consensus among study participants that formal community-based support (e.g., handibus, caregiving relief, rehabilitation assessments) should be continued for extended periods (e.g., years) post-stroke. Ongoing contact with health care professionals is valuable to help them navigate in the community as needs change over time.

Development of appropriateness explicit criteria for cataract extraction by phacoemulsification

Background: Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cataract extraction. We developed a new appropriateness of indications tool for cataract following the RAND method. We tested the validity of our panel results. Methods: Criteria were developed using a modified Delphi panel judgment process. A panel of 12 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the influence of all variables on the final panel score using linear and logistic regression models. The explicit criteria developed were summarized by classification and regression tree analysis. Results: Of the 765 indications evaluated by the main panel in the second round, 32.9% were found appropriate, 30.1% uncertain, and 37% inappropriate. Agreement was found in 53% of the indications and disagreement in 0.9%. Seven variables were considered to create the indications and divided into three groups: simple cataract, with diabetic retinopathy, or with other ocular pathologies. The preoperative visual acuity in the cataractous eye and visual function were the variables that best explained the panel scoring. The panel results were synthesized and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel original criteria, was 5.3%. Conclusion: The parameters tested showed acceptable validity for an evaluation tool. These results support the use of this indication algorithm as a screening tool for assessing the appropriateness of cataract extraction in field studies and for the development of practice guidelines.

Assessing trends in the density of Atlantic croaker (Micropogonias undulatus): a comparison of passive acoustic and trawl methods

Using data collected simultaneously from a trawl and a hydrophone, we found that temporal and spatial trends in densities of juvenile Atlantic croaker (Micropogonias undulatus) in the Neuse River estuary in North Carolina can be identified by monitoring their sound production. Multivariate analysis of covariance (MA NCOVA) revealed that catch per unit of effort (CPUE) of Atlantic croaker had a significant relationship with the dependent variables of sound level and peak frequency of Atlantic croaker calls. Tests of between-subject correspondence failed to detect relationships between CPUE and either of the call parameters, but statistical power was low. Williamson’s index of spatial overlap indicated that call detection rate (expressed by a 0–3 calling index) was correlated in time and space with Atlantic croaker CPUE. The correspondence between acoustic parameters and trawl catch rates varied by month and by habitat. In general, the calling index had a higher degree of overlap with this species’ density than did the received sound level of their calls. Classification and regression tree analysis identified calling index as the strongest correlate of CPUE. Passive acoustics has the potential to be an inexpensive means of identifying spatial and temporal trends in abundance for soniferous fish species.

Relationships between secchi disk visibility, water temperature and dissolved oxygen in freshwater fishpond

A study was conducted to determine the relationships between secchi disk variability, water temperature and dissolved oxygen in fish ponds. Multiple regression correlation analysis was done to evaluate the relationships between the variables. Results indicated that the ranges of secchi disk visibility, water temperature and dissolved oxygen in the study ponds were just within the ranges of the variables for tilapia culture. Multiple regression correlation showed no (or insignificant) relationships with dissolved oxygen and water temperature, dissolved oxygen with secchi disk visibility and water temperature with secchi disk visibility.

Survey of plankton blooms and red tides and their interaction with environmental factors through monitoring satellite images

One of the most important marine ecological phenomena is red tide which is created by increasing of phytoplankton population, influenced by different factors such as climate condition changes, utrification hydrological factors and can leave sever and undesired ecological and economical effects behind itself in the case of durability. Coast line of Hormozgan is about 900km from east to west, within the range of geographical coordinates of 56 16 23.8, 26 58 8.8 to 54 34 5.33 and 26 34 32 eastern longitude and northern latitude, seven sampling stations were considered and sampled for a period of one year from October 2008 to October 2009. after the analysis of Satellite images, monthly, during the best time. In several stages, samplings were performed. In each station, three samples were collected for identification and determination of Bloom- creating species abundance. Cochlodinium polykrikoides was the species responsible for the discoloration which occurred at October 2008 in Hormozgan marine water. Environmental parameters such as sea surface temperature, pH, salinity, Dissolved Oxygen concentration, Total Dissolved Solids (T.D.S.), conductivity, nitrate, nitrite and phosphate and also chlorophyll a were measured and calculated. Kruscal Wallis test was used to compare the densities between different months, seasons and the studied stations. Mann-whitney test from Nonparametric Tests was used for couple comparison. Pearson correlation coefficient was used to determine the relationship between physical and chemical data set and the abundance of Cochlodinium polykrikoides. Multivariate Regression and analysis of variance (ANOVA) also were used to obtain the models and equations of red tide occurrence relationship, environmental parameters and nutrient data. The highest density was 26 million cells per liter in Qeshm station. A meaningful difference was observed between sampling months and seasons but there was no between sampling stations which indicates that in favorable conditions, the occurrence of this phenomenon by the studied species is probable. Regarding to β coefficients of nitrate, temperature, phosphate, Total Dissolvable Solutions (T.D.S) and pH these parameters are effective on the abundance of this species and red tide occurrence. Increase in these factors can represent the effects and outcomes of human activities and increase in marine pollution.

Biodiversity and production of bioactive material from cyanobacteria in Persian Gulf

In this project sampling was done from 9 stations in 3 depths during 5 seasons to separate, identify and examine the biodiversity of cyanobacteria. Another sampling also has been done to analyse all physical and physicochemical parameters, primary production and polluting agents such as heavy metals and oil hydrocarbons in water and sediments. Along with optimization of Oscillatoria to study the ability of producing natural substances, these cyanobacteria were analysed from the point of antimicrobial and mutagenic effects. To examine the relationships among analysed parameters, the regression test, analysis of varian and Post Hoc were used. As the result of this study 48 genus of cyanobacteria were pecognised among which 35.5% were croco ccales and 64.4% were Hermogonals. Oscillatoria was one of the Filamentous cyanobacteria which had antibacterial and mutagenic effects. The results of multicommunity consistency varians test, post Hoc and homogenous subsets show significant difference between biodiversity of cyanotbacteria in coral ecosystem, Mangrove and transite. The linear correlation coefficient between biodiversity of cyanobacteria and bioenvironmental agents were examined, but there was no continuous relation between these factors and biological biodiversity. In Surface layer there was a significant correlation coefficent at 0.048 and probability at 95% confidence interval. Also, the biodiversity is depended on oil pollution and heavy metals such as copper (Cu) and chromium (Cr).

Fast Haar Transform Based Feature Extraction for Face Representation and Recognition

Subspace learning is the process of finding a proper feature subspace and then projecting high-dimensional data onto the learned low-dimensional subspace. The projection operation requires many floating-point multiplications and additions, which makes the projection process computationally expensive. To tackle this problem, this paper proposes two simple-but-effective fast subspace learning and image projection methods, fast Haar transform (FHT) based principal component analysis and FHT based spectral regression discriminant analysis. The advantages of these two methods result from employing both the FHT for subspace learning and the integral vector for feature extraction. Experimental results on three face databases demonstrated their effectiveness and efficiency.

Gender-specific genomic profiling in metastatic colorectal cancer patients treated with 5-fluorouracil and oxaliplatin

AIMS: Survival and response rates in metastatic colorectal cancer remain poor, despite advances in drug development. There is increasing evidence to suggest that gender-specific differences may contribute to poor clinical outcome. We tested the hypothesis that genomic profiling of metastatic colorectal cancer is dependent on gender.

MATERIALS & METHODS: A total of 152 patients with metastatic colorectal cancer who were treated with oxaliplatin and continuous infusion 5-fluorouracil were genotyped for 21 polymorphisms in 13 cancer-related genes by PCR. Classification and regression tree analysis tested for gender-related association of polymorphisms with overall survival, progression-free survival and tumor response.

RESULTS: Classification and regression tree analysis of all polymorphisms, age and race resulted in gender-specific predictors of overall survival, progression-free survival and tumor response. Polymorphisms in the following genes were associated with gender-specific clinical outcome: estrogen receptor β, EGF receptor, xeroderma pigmentosum group D, voltage-gated sodium channel and phospholipase A2.

CONCLUSION: Genetic profiling to predict the clinical outcome of patients with metastatic colorectal cancer may depend on gender.

Avaliação imobiliária: entre a ciência da avaliação e a arte da apreciação

Recentemente a avaliação imobiliária levou ao colapso de instituições financeiras e à crise no Subprime. A presente investigação pretende contribuir para perceber quais os factores preponderantes na avaliação imobiliária. O trabalho aborda a problemática da assimetria de informação, os diferentes métodos de avaliação imobiliária e a importância das externalidades. Empiricamente há diversos casos analisados através do uso da metodologia da Regressão Linear, Análise de Clusters e Análise de Componentes Principais da Análise Factorial. O primeiro caso analisado é direccionado à avaliação das externalidades, onde os resultados indicam que as externalidades positivas principais são as seguintes: as vistas de marina são mais valorizadas que as vistas de mar, as vistas frontais são mais valorizadas que as vistas laterais e existem diferenças de valorização ao nível do piso de acordo com o tipo de habitação (residência ou férias). O segundo estudo analisa como o método do rendimento ajuda na explicação da realidade portuguesa, no qual foram obtidos três clusters de rendas e três clusters de yields para cada uma das amostras. Os resultados demonstram que: (a) ambos os clusters, das yields e das rendas são formados por diferentes elementos (b) que o valor da oferta é explicado pelo método do rendimento, pelo cluster das yields e pela densidade populacional. No terceiro estudo foram inquiridos 427 indivíduos que procuravam apartamento para residência. A partir da Análise de Componentes Principais da Análise Factorial efectuada obtiveram-se sete factores determinantes na procura de apartamento: as externalidades negativas, as externalidades positivas, a localização de negócios no rés-do-chão do edifício de apartamentos, os interesses racionais de proximidade, as variáveis secundárias na utilização do edifício, as variáveis de rendimento e as variáveis de interesses pessoais. A principal conclusão é que como é uma área transdisciplinar, é difícil chegar a um único modelo que incorpore os métodos de avaliação e as diferentes dinâmicas da procura. O avaliador, deve analisar e fazer o seu scoring, tendo em conta o equilíbrio entre a ciência da avaliação e a arte da apreciação.

Identification of Predictive Factors of BMI and High Risk Hypertension in Rural Nicaraguan Community

Thesis (Master's)--University of Washington, 2013

Facteurs de risque de chutes chez les aînés vivant dans la communauté et ayant recours aux services de soutien à domicile : covariables dépendantes du temps et événements récurrents

Les chutes chez les personnes âgées représentent un problème majeur. Il n’est donc pas étonnant que l’identification des facteurs qui en accroissent le risque ait mobilisé autant d’attention. Les aînés plus fragiles ayant besoin de soutien pour vivre dans la communauté sont néanmoins demeurés le parent pauvre de la recherche, bien que, plus récemment, les autorités québécoises en aient fait une cible d’intervention prioritaire. Les études d’observation prospectives sont particulièrement indiquées pour étudier les facteurs de risque de chutes chez les personnes âgées. Leur identification optimale est cependant compliquée par le fait que l’exposition aux facteurs de risque peut varier au cours du suivi et qu’un même individu peut subir plus d’un événement. Il y a 20 ans, des chercheurs ont tenté de sensibiliser leurs homologues à cet égard, mais leurs efforts sont demeurés vains. On continue aujourd’hui à faire peu de cas de ces considérations, se concentrant sur la proportion des personnes ayant fait une chute ou sur le temps écoulé jusqu’à la première chute. On écarte du coup une quantité importante d’information pertinente. Dans cette thèse, nous examinons les méthodes en usage et nous proposons une extension du modèle de risques de Cox. Nous illustrons cette méthode par une étude des facteurs de risque susceptibles d’être associés à des chutes parmi un groupe de 959 personnes âgées ayant eu recours aux services publics de soutien à domicile. Nous comparons les résultats obtenus avec la méthode de Wei, Lin et Weissfeld à ceux obtenus avec d’autres méthodes, dont la régression logistique conventionnelle, la régression logistique groupée, la régression binomiale négative et la régression d’Andersen et Gill. L’investigation est caractérisée par des prises de mesures répétées des facteurs de risque au domicile des participants et par des relances téléphoniques mensuelles visant à documenter la survenue des chutes. Les facteurs d’exposition étudiés, qu’ils soient fixes ou variables dans le temps, comprennent les caractéristiques sociodémographiques, l’indice de masse corporelle, le risque nutritionnel, la consommation d’alcool, les dangers de l’environnement domiciliaire, la démarche et l’équilibre, et la consommation de médicaments. La quasi-totalité (99,6 %) des usagers présentaient au moins un facteur à haut risque. L’exposition à des risques multiples était répandue, avec une moyenne de 2,7 facteurs à haut risque distincts par participant. Les facteurs statistiquement associés au risque de chutes incluent le sexe masculin, les tranches d’âge inférieures, l’histoire de chutes antérieures, un bas score à l’échelle d’équilibre de Berg, un faible indice de masse corporelle, la consommation de médicaments de type benzodiazépine, le nombre de dangers présents au domicile et le fait de vivre dans une résidence privée pour personnes âgées. Nos résultats révèlent cependant que les méthodes courantes d’analyse des facteurs de risque de chutes – et, dans certains cas, de chutes nécessitant un recours médical – créent des biais appréciables. Les biais pour les mesures d’association considérées proviennent de la manière dont l’exposition et le résultat sont mesurés et définis de même que de la manière dont les méthodes statistiques d’analyse en tiennent compte. Une dernière partie, tout aussi innovante que distincte de par la nature des outils statistiques utilisés, complète l’ouvrage. Nous y identifions des profils d’aînés à risque de devenir des chuteurs récurrents, soit ceux chez qui au moins deux chutes sont survenues dans les six mois suivant leur évaluation initiale. Une analyse par arbre de régression et de classification couplée à une analyse de survie a révélé l’existence de cinq profils distinctifs, dont le risque relatif varie de 0,7 à 5,1. Vivre dans une résidence pour aînés, avoir des antécédents de chutes multiples ou des troubles de l’équilibre et consommer de l’alcool sont les principaux facteurs associés à une probabilité accrue de chuter précocement et de devenir un chuteur récurrent. Qu’il s’agisse d’activité de dépistage des facteurs de risque de chutes ou de la population ciblée, cette thèse s’inscrit dans une perspective de gain de connaissances sur un thème hautement d’actualité en santé publique. Nous encourageons les chercheurs intéressés par l’identification des facteurs de risque de chutes chez les personnes âgées à recourir à la méthode statistique de Wei, Lin et Weissfeld car elle tient compte des expositions variables dans le temps et des événements récurrents. Davantage de recherches seront par ailleurs nécessaires pour déterminer le choix du meilleur test de dépistage pour un facteur de risque donné chez cette clientèle.

Factores de riesgo para mortalidad quirúrgica en menores de un año con cardiopatía congénita

OBJETIVOS Identificar factores asociados a mortalidad en pacientes menores de 1 año de edad operados de cardiopatía congénita en la Fundación Cardioinfantil I.C, en el periodo entre agosto uno de 2004 a Diciembre 31 de 2007. MÉTODOS: Estudio observacional analítico descriptivo de casos y controles en el periodo señalado. Se revisaron 290 pacientes de las cuales 60 fueron casos y 230 a controles. Se realizo análisis bivariable con la Razón de Riesgo (Odds Ratio - OR) e intervalos de confianza del 95% y Posteriormente se realizo una regresión logística incondicional (multivariante) para análisis de los factores en conjunto asociado.